LETTERS TO THE EDITORS

ABSTRACT

Alcohol and marijuana are the most commonly used substances for college-attending young adults. This study evaluated differences in substance-specific consequence attribution by alcohol-marijuana use patterns (concurrent alcohol and marijuana [CAM; use of both substances, not at same time] and simultaneous [SAM; use of both, at same time]) as well as alcohol-only (AO). First-year college students with prior alcohol use (N = 610, 50.9% women, 71% White, M_age = 18) completed an online assessment of past-three-month substance use, including SAM, and related consequences. Results indicated that polydrug (SAM and CAM) users reported greater alcohol involvement and earlier alcohol initiation than AO, and polydrug use was associated with more alcohol-related problems, including sexual risk taking and alcohol-related blackouts. When restricted to SAM/CAM users, logistic regressions indicated that SAM users reported an increased incidence in two marijuana-related problems relative to CAM (driving after using and academic difficulties), but lower rates of social problems. SAM users were also less likely to attribute substance-related social problems to alcohol. Overall, findings highlight variations that exist within alcohol-marijuana polydrug users and show areas to consider for intervention development and future research.     

High-intensity and simultaneous alcohol and marijuana use among high school seniors in the United States

Background: Simultaneous alcohol and marijuana (SAM) use poses threats to health, particularly among adolescents. These risks would be exacerbated to the extent that high-intensity drinking (e.g., 10+ drinks in a row) and marijuana use (e.g., 1+ joints per day) are associated with a higher likelihood of SAM use. The current study examines the extent to which the intensity of alcohol use and of marijuana use are associated with adolescent SAM use prevalence, and whether associations remain after controlling for key covariates known to associate with both alcohol and marijuana use; it identifies alcohol and marijuana use intensity levels associated with the highest risk of adolescent SAM use. Methods: Data come from nationally representative samples of US 12th graders who participated in the Monitoring the Future study from 2005 to 2014 (N = 24,203 respondents; 48.4% boys, 51.6% girls). Results: SAM use during the past year was reported by 20% of 12th graders overall. SAM use prevalence was strongly and positively associated with alcohol and marijuana use intensity even after controlling for covariates. High school seniors at highest risk for engaging in SAM use were those who reported 10+ drinks and those smoking at least 1 joint/day. Approximately 60% of those who had 10–14 or 15+ drinks in a row during the past 2 weeks and 76%–80% of those who had 1 or 2+ joints per day on average during the past 30 days reported SAM use. Conclusions: Results suggest that high school seniors who consume high quantities of alcohol and marijuana are very likely to consume these substances so that their effects overlap.     

The Link Between Substance Use and Reproductive Health Service Utilization Among Young US Women

ABSTRACT. Background: The authors sought to investigate associations between young women's use of alcohol and other substances and their sexual and reproductive health (SRH) service utilization. Methods: The authors used data from 4421 young women aged 15–24 years in the nationally representative study, National Survey of Family Growth, 2002–2008. The authors examined associations between frequency of tobacco, alcohol, marijuana, and illicit drug use and SRH service use in the past year using logistic regression. Results: Over half (59%) of the young women used SRH services, including contraception (48%), gynecological examination (47%), and sexually transmitted infection (STI) testing/treatment (17%) services. Proportions of SRH service use increased with higher frequencies of substance use (all P values <.001); service use was particularly common among daily substance users (range: 72% of daily marijuana users to 83% of daily binge drinkers). In multivariable analyses, associations between substance and SRH service use varied by substance and service type: weekly marijuana (odds ratio [OR] = 2.5, 95% confidence interval [95% CI] = 1.4, 4.3, P = .002) and alcohol (OR = 1.7, 95% CI = 1.1, 2.4, P = .01) use were positively associated with gynecological service use. All substances were positively associated with STI service use. However, daily smoking was negatively associated with contraceptive service use (OR = 0.6, 95% CI = 0.4, 0.8, P = .001). Conclusion: SRH service use was common among women reporting frequent substance use. SRH settings provide an opportunity to deliver substance use screening and preventive care to young women.     

Marijuana and Alcohol Use and Attempted Smoking Cessation in Adolescent Boys and Girls

ABSTRACT. Background: This study sought to determine the relationship between the frequency of current marijuana and alcohol use and cigarette quit attempts in male and female adolescent smokers. Methods: Data from a cross-sectional survey of health behaviors in high-school-aged adolescents were analyzed. Current cigarette smokers (n = 804) who reported use of at least 1 cigarette in the past month were divided into those with and without a history of at least 1 quit attempt (a self-reported episode of trying to “stop smoking”). Logistic regression models were fit to describe the association between the frequency of marijuana/alcohol use and a history of cigarette quit attempts. Results: Among the total sample, higher-frequency marijuana use (more than 6 times in the past 30 days) and frequent binge drinking (more than 5 days of binge drinking in the past 30 days) decreased the odds of having a past cigarette quit attempt (higher-frequency marijuana: adjusted odds ratio [AOR] = 0.56, 95% confidence interval [CI] = 0.36–0.86; frequent binge drinking: AOR = 0.49, 95% CI = 0.29–0.83). A significant gender interaction was observed for the relationship between higher-frequency marijuana use and a history of cigarette quit attempts (P = .03), with decreased odds in boys (AOR = 0.41, 95% CI = 0.22–0.77) but not in girls (AOR = 0.71, 95% CI = 0.37–1.33). Conclusions: Adolescent smokers who report higher-frequency marijuana use or frequent binge drinking have a decreased likelihood of a history of a cigarette quit attempt. The gender-related association between higher-frequency marijuana use and a history of quit attempts suggests that boys with greater substance use may need particularly intensive support to initiate quit attempts.     

Motives for and impairment associated with alcohol and marijuana use among college students

IntroductionAlcohol and marijuana use are prevalent on college campuses. As recreational marijuana use is legalized, more undergraduate students may use marijuana in combination with alcohol. The motives for, frequency of, and impairment associated with dual use (alcohol and marijuana) compared to alcohol-only use may differ. We examined motives for, frequency of, and impairment associated with alcohol use and dual use at a university in a state where recreational marijuana has been legalized.MethodUndergraduate college students completed an anonymous online survey (N = 430) concerning alcohol and marijuana frequency, motives, and impairment. Students were classified as either alcohol-only users (n = 279) or dual users (n = 151).ResultsAnalyses indicated that among alcohol-only users, social motives predicted more alcohol use, while among dual users, enhancement motives predicted more alcohol and marijuana use and impairment. Coping motives predicted more marijuana use among dual users, but not more alcohol use. Frequency of alcohol and marijuana use predicted more impairment across both the alcohol-only and dual users.ConclusionsFuture research should examine the influence of marijuana use over time to understand how motives may change for previous alcohol-only users.     

Age of First Use as a Predictor of Current Alcohol and Marijuana Use Among College-Bound Emerging Adults

Background: Alcohol and marijuana are the most commonly used psychoactive substances; however, the sequencing and relationship between age of first use and continued current problematic use among college-bound emerging adults is not well understood.

Methods: This is a cross-sectional study of current and historical alcohol and marijuana use among college-bound recent high school graduates (N = 1,365; age ～18 years).

Results: Drinking was prevalent (78%, N = 1,055) and marijuana use was prevalent (46%, N = 622). Stepwise logistical regression revealed the lower the age of first use, the higher the prevalence of current problematic substance use. Those who initiate alcohol ≤ 12 are twice as likely to currently use marijuana frequently. A significant relationship was found between age of first use and non-social substance use (drinking, p = 0.0001; marijuana, p = 0.0025). The temporal ordering of substance use indicates that alcohol precedes marijuana use, and age of first alcohol use is relevant to rates of initiation and current marijuana use.     

Simultaneous alcohol and marijuana use among US high school seniors from 1976 to 2011: Trends,reasons, and situations

Background

Simultaneous alcohol and marijuana (SAM) use raises significant concern due to the potential for additive or interactive psychopharmacological effects. However, no nationally representative studies are available that document prevalence, trends, or related factors in US youth SAM use.

Methods

Nationally representative cross-sectional samples of 12th grade students surveyed in the Monitoring the Future project from 1976 to 2011 provided data on SAM use. Analyses were conducted in 2012.

Results

In 2011, 23% of all US high school seniors reported any SAM use. Among seniors reporting any past 12-month marijuana use, 62% reported any SAM use and 13% reported SAM use most or every time they used marijuana. SAM use consistently followed trends for past 30-day alcohol use over time. SAM use showed significant variation by psychosocial and demographic characteristics and was strongly associated with higher substance use levels, but occurred across the substance use spectrum. Certain reasons for alcohol or marijuana use (to increase effects of another drug; I’m hooked) and situations of alcohol or marijuana use (park/beach, car, party) were strongly associated with SAM use.

Conclusions

A sizable proportion of US high school seniors reported SAM use, and it appeared to occur frequently in social use situations that could impact both the public as well as youth drug users. SAM use appears to be a complex behavior that is incidental to general substance use patterns as well as associated with (a) specific simultaneous reasons (or expectancies), and (b) heavy substance use and perceived dependence, especially on alcohol.     

Prevalence of marijuana and other substance use before and after Washington State's change from legal medical marijuana to legal medical and nonmedical marijuana: Cohort comparisons in a sample of adolescents

ABSTRACT

Background: A growing number of states have new legislation extending prior legalization of medical marijuana by allowing nonmedical marijuana use for adults. The potential influence of this change in legislation on adolescent marijuana and other substance use (e.g., spillover or substitution effects) is uncertain. We capitalize on an ongoing study to explore the prevalence of marijuana and other substance use in 2 cohorts of adolescents who experienced the nonmedical marijuana law change in Washington State at different ages. Methods: Participants were 8th graders enrolled in targeted Tacoma, Washington public schools and recruited in 2 consecutive annual cohorts. The analysis sample was 238 students who completed a baseline survey in the 8th grade and a follow-up survey after the 9th grade. Between the 2 assessments, the second cohort experienced the Washington State nonmedical marijuana law change, whereas the first cohort did not. Self-report survey data on lifetime and past-month marijuana, cigarette, and alcohol use were collected. Results: Multivariate multilevel modeling showed that cohort differences in the likelihood of marijuana use were significantly different from those for cigarette and alcohol use at follow-up (adjusting for baseline substance initiation). Marijuana use was higher for the second cohort than the first cohort, but this difference was not statistically significant. Rates of cigarette and alcohol use were slightly lower in the second cohort than in the first cohort. Conclusions: This exploratory study found that marijuana use was more prevalent among teens shortly after the transition from medical marijuana legalization only to medical and nonmedical marijuana legalization, although the difference between cohorts was not statistically significant. The findings also provided some evidence of substitution effects. The analytic technique used here may be useful for examining potential long-term effects of nonmedical marijuana laws on adolescent marijuana use and substitution or spillover effects in future studies.     

The Role of Impulsivity and Expectancies in Predicting Marijuana Use: An Application of the Acquired Preparedness Model

ABSTRACT

Impulsivity and substance use covary. Smith and Anderson’s acquired preparedness model proposes that impulsivity predicts substance use through a mediational model such that substance use expectancies mediate the relation between impulsivity and drug use. The present study seeks to examine the relation between positive urgency, an important component of impulsivity with specific relations to substance use behavior, marijuana expectancies, and marijuana use patterns. The study focused on a sample of frequent marijuana users (n = 3,616) and assessed positive urgency using the UPPS-P, expectancies using the Biphasic Marijuana Effects Scale, an adapted form of the Biphasic Alcohol Effects Scale to measure the sedative and stimulant properties of marijuana, and also assessed use patterns. Findings suggest that stimulant expectancies predict heavier, more frequent marijuana use than sedative expectancies and that marijuana expectancies vary based on the limb of marijuana intoxication. Examination of the acquired preparedness model revealed that positive urgency’s link to marijuana use was fully mediated by expectancies.     

Don’t wake and bake: morning use predicts cannabis problems

Heavy, frequent cannabis use covaries with cannabis-associated problems. With cannabis policy changing worldwide, identifying risk factors for cannabis-associated problems is crucial. While researchers have consistently studied frequency and quantity of use as important risks, clinical lore suggests that the timing of use might also contribute to problems. Similar to morning use of alcohol among alcohol-dependent individuals, morning use of marijuana may indicate dependence and increased cannabis-related impairment. Morning use also has the potential to lend itself to straightforward intervention. The present study sought to examine the relation between morning cannabis use and self-reported cannabis-associated problems. The study compared daily marijuana users who reported morning use (n?=?257) to daily marijuana users who reported no use before noon (n?=?76) using the brief Cannabis-Associated Problems Questionnaire. Morning users reported significantly more problems than non-morning users, and morning use accounted for significant unique variance in problems. Exploratory mediational analyses did not support the idea that morning use led to problems via withdrawal. The present study provides evidence that timing of cannabis use is an important factor in examining the cannabis-associated problems.     

Is marijuana identity associated with marijuana use and consequences? An examination of direct and interactive associations

Background: There is relatively little research examining the relationship between identity and marijuana-related outcomes (e.g., marijuana use and consequences). Identity may both directly help shape marijuana use behaviors and moderate the influence of other risk factors on marijuana outcomes. Objectives: The current study examines the relationship between marijuana identity and marijuana-related outcomes among emerging adults and explores whether identity moderates the relationships between nonidentity correlates (e.g., perceived norms and negative affect) of marijuana-related outcomes. Methods: College students who reported marijuana use in the past 12?months completed measures of marijuana identity, perceived norms, negative affect, frequency of marijuana use, and marijuana consequences. Conclusions/Importance: The results indicated that marijuana identity is associated with marijuana use frequency and moderates the relationship between perceived norms and marijuana consequences. The findings have implications for both identity-based and social norms-based interventions targeting problematic marijuana use among emerging adults.     

Dual cannabis and alcohol use disorders in young adults: Problems magnified

ABSTRACT

Background: Alcohol and marijuana are the 2 most commonly used substances among young adults. The present study examines whether having 2 DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) diagnoses (alcohol and cannabis) is associated with greater problems than having 1 (alcohol or cannabis) diagnosis. Methods: Participants were 307 young adults (18–25 years) from the community who met criteria for DSM-5 alcohol use disorder (AUD), cannabis use disorder (CUD), or both (dual use disorder [DUD]). Participants reported alcohol and marijuana use in the past 90 days (Timeline Follow-Back), alcohol problems (Short Inventory of Problems), and marijuana problems (Marijuana Problems Scale). Results: Eighty-four participants (27.4%) met criteria for AUD, 107 (34.9%) met criteria for CUD, and 116 (37.8%) met criteria for DUD. In multivariate analyses, the DUD group reported greater alcohol use frequency and more alcohol problems than the CUD-only group but not the AUD-only group. However, DUD individuals reported greater drinking intensity than singly diagnosed individuals. Those with DUD reported a greater proportion of marijuana consumption days than the AUD-only group but not the CUD-only group. However, DUD individuals reported more marijuana problems than both singly diagnosed groups. Conclusions: Results show that the concurrent presence of both DSM-5 AUD and CUD is associated with heavier drinking patterns and greater marijuana problems than disordered use of either substance alone, thus affirming the magnified severity of alcohol and marijuana use that accompanies dual DSM-5 alcohol and marijuana use disorders.     

Mostly Smokers: Identifying Subtypes of Emerging Adult Substance Users

Background: The concurrent use of marijuana and other substances among emerging adults (ages 18–25) is a major public health problem. This study examined if there are distinct subtypes of emerging adult marijuana users and if these are associated with demographic and substance use variables. Methods: The design was a cross-sectional interview with a community sample of 1,503 emerging adults in the northeastern U.S. who reported last month marijuana use. We used latent class analysis (LCA) to identify distinct subtypes of emerging adults who used additional substances and examined predictors of the latent classes. Results: We identified three distinct classes of emerging adults who use substances: “mostly smokers” (those who primarily use marijuana and nicotine), “moderate users” (those who primarily use marijuana and/or heavy episodic alcohol), and “polysubstance users.” Polysubstance users had higher probabilities of use of all assessed substances (e.g. cocaine, opiates, sleep medications, stimulants, synthetic marijuana, and inhalants) than the other two groups. Not being currently enrolled in school and male gender were associated with mostly smokers and polysubstance users group status. Conclusions: We identified a distinct group of emerging adult marijuana users who primarily smoke marijuana and cigarettes, suggesting that there could be a shared vulnerability for risk of co-occurrence.     

African–American Women’s Tobacco and Marijuana Use: The Effects of Social Context and Substance Use Perceptions

Background: Despite the status of tobacco and marijuana as two of the most commonly used substances in the U.S., both have detrimental health and social consequences for disfranchized African–Americans. Substance use may be shaped by social contextual influences from families and peers in African–American communities, and little research has examined perceptions of wrongfulness, harms, and dangers associated with daily tobacco and marijuana use among African–American women. Objectives: This study explores the effects of African–American women’s social context and substance use perceptions (wrongfulness/harmfulness/dangerousness) on daily tobacco and marijuana use. Methods: Survey data was collected in-person from 521 African–American women. Multivariate logistic models identified the significant correlates of women’s daily use of tobacco and marijuana in the past six months. Results: 52.59% of participants reported daily tobacco use and 10.56% used marijuana daily. Multivariate models indicated that women were more likely to be daily tobacco users if they had a family member with a substance use problem or perceived tobacco use to be wrong, harmful, or more dangerous than marijuana. In the models with marijuana as the dependent variable, women who lived with a person who used drugs were more likely to use marijuana daily. Perceiving marijuana use as wrong or harmful to one’s health was protective against daily marijuana use. Conclusions: Findings stress the need for prevention and intervention efforts for African–American women that highlight social context influences and promote greater awareness of the health risks associated with daily tobacco and marijuana use.     

Binge Drinking,Marijuana Use,and Friendships: The Relationship Between Similar and Dissimilar Usage and Friendship Quality

Abstract

While it is commonly understood that the substance use of peers influences an individual's substance use, much less is understood about the interplay between substance use and friendship quality. Using a sample of 2,148 emerging adults nested within 1,074 dyadic friendships, this study separately investigates how concordance and discordance in binge drinking and marijuana use between friends is related to each friend's perceptions of friendship quality. Because “friendship quality” is a complex construct, we employ a measure containing five sub-elements – companionship, a lack of conflict, willingness to help a friend, relationship security, and closeness. Results for both binge drinking and marijuana use reveal that individuals in friendship pairs who are concordant in their substance use perceive significantly higher perceptions of friendship quality than individuals in dyads who are dissimilar in substance use. Specifically, concordant binge drinkers estimate significantly higher levels of companionship, relationship security, and willingness to help their friend than concordant non-users, discordant users, and discordant non-users. However, the highest amount of conflict in friendships is found when both friends engage in binge drinking and marijuana use. Several interpretations of these findings are discussed. Overall, concordance between friends’ binge drinking and marijuana use appears to help some elements of friendship quality and harm others.     

The Relationship of Stress and Coping Methods to Adolescent Marijuana Use

As the use of marijuana among adolescents remains high, more effective interventions are needed. We conducted this cross-sectional survey at an outpatient, university-based, adolescent clinic to determine the prevalence of marijuana use in an inner-city adolescent population and to examine the relationship of stress and coping methods to marijuana user status (never user, experimenter, and frequent user). The subjects were 918 adolescents aged 12–21 years. Lifetime use in this population was 59% (n = 611) with 18.4% (n = 191) reporting frequent weekly use. Almost all (97%) marijuana users acknowledged marijuana use by friends. Stepwise logistic regression analysis showed that negative life events, greater use of the negative coping method of anger and less frequent use of the positive coping method of parental support were significantly and independently related to marijuana user status. In the presence of high peer use, exploring parent–child relationships and use of anger coping and intervening accordingly may decrease marijuana use.     

Violent Behavior as Related to Use of Marijuana and Other Drugs

Abstract

The relationship of the degree of use of each of ten types of illicit drugs with each of eight types of violent criminal offenses, is reported for an African-American, inner-city, low SES, young adult study sample (N = 612). Prospective data from the time of birth was available for the statistical analyses, to provide 51 control variables on factors other than substance use which might predict to later violent behavior.

Findings: Greater frequency of use of marijuana was found unexpectedly to be associated with greater likelihood to commit weapons offenses; and this association was not found for any of the other drugs, except for alcohol. Marijuana use was also found associated with commission of Attempted Homicide/Reckless Endangerment offenses. Cocaine/crack and marijuana were the only two types of drugs the frequency of use of which was found, for this sample, to be significantly related to the frequency of being involved in the selling of drugs. These findings may not apply to a middle-class African-American sample.     

Anxiety Symptoms and Coping Motives: Examining a Potential Path to Substance Use-Related Problems in Adolescents With Psychopathic Traits

Background: Although the relation between impulsive-irresponsible psychopathic traits and substance use is well-documented, the path to developing substance use problems is less understood in adolescents with these characteristics. Objectives: To examine the associations between psychopathy, anxiety, and substance use motives and a mechanism by which anxiety and alcohol and marijuana coping motives mediate the relation between psychopathic traits and substance use-related problems. Methods: A sample of 185 at-risk adolescent males from a residential military-style program reporting past alcohol or marijuana use (M age = 16.74) participated in the study. Results: Impulsive-Irresponsible psychopathic traits were uniquely and incrementally predictive of alcohol and marijuana use-related problems and anxiety. Anxiety and coping motives appeared to partially explain the association between impulsivity-irresponsibility and substance use-related problems. Conclusions/Importance: Findings suggest that youth expressing impulsive-irresponsible psychopathic traits may engage in problematic substance use at least partly as a function of heightened anxiety and a subsequent desire to alleviate distress by using alcohol or marijuana to cope.